Clinical Impact of Preoperative Magnetic Resonance Imaging in the Evaluation of Myometrial Infiltration and Lymph-Node Metastases in Stage I Endometrial Cancer

Abstract

Purpose: In the developed world, endometrial cancer is one of the most common malignant gynecological cancer types. Due to the highly available diagnostic modalities and patient education, the early detection of the tumor leads to high overall survival.Methods: In this study we analyzed the reliability of preoperative MRI findings in the staging of early stage endometrial cancer, as well as the clinical characteristics of patients underwent radical hysterectomy and the histopathologic evaluation of their tumor, with the retrospective data of radical hysterectomies performed in our hospital between 2010 and 2019.Results: The accuracy, sensitivity, specificity, negative- and positive predictive value of MRI regarding stage were 94.7, 63.3, 94.8, 83.8, and 83.8%, respectively. The accuracy, sensitivity, specificity, negative- and positive predictive value of MRI for the detection of the myometrial invasion were 69.8, 80.0, 60.8, 64.3, and 77.5%, respectively. The accuracy, sensitivity, specificity, negative- and positive predictive value of MRI for the detection of lymph node metastases were 78.1, 28.6, 82, 11.1, and 93.6%, respectively.Conclusions: Based on our results, MRI is the method of choice in terms of evaluating overall staging, as well as myometrial invasion, as its specificity and negative predictive value are relatively high. However, systematic lymphadenectomy showed improved cancer-related survival and recurrence-free survival. Our studies showed that the diagnosis of lymph node metastases is difficult with MRI modality since hyperplastic and metastatic nodes cannot easily differentiate, leading to a high percentage of false-positive results. Therefore, other imaging modalities may be used for more accurate evaluation. New findings of our study were that the role of the radiologist’s expertise in the evaluation of MR imaging plays an essential role in lowering false-negative and false-positive results. Therefore, findings evaluated by a radiologist with high-level expertise in gynecological imaging can complement the clinical findings and help substantially define the needed treatment.

ESGO/ESHRE/ESGE Guidelines for the fertility-sparing treatment of patients with endometrial carcinoma

“…PET-CT shows the highest specificity but a moderate sensitivity for detecting lymph node metastasis. The choice of the diagnostic tool (US, CT, PET-CT, MRI) should be made individually according to the patient’s characteristics and imaging accessibility ( Bi et al, 2020 ; Bus et al, 2021 ; Xu et al, 2019 ; Yang et al, 2019 ). Synchronous or metastatic ovarian cancer occurs in 5–29% of patients with endometrial carcinoma, and younger women <45 years of age are five times more likely to have synchronous ovarian cancer than women aged >45 years ( Obermair et al, 2020 ).…”

Radiomics in Gynaecological Imaging: A State-of-the-Art Review

“…However, this criterion has a low specificity because hyperplastic nodes can also be enlarged, which may lead to a high percentage of false-positive results. At the same time, it has been demonstrated that nodes with a short axis lower than 1 cm are sometimes proved as metastatic at pathology [24,35].…”

Comparison of the diagnostic accuracy of contrast-enhanced/DWI MRI and ultrasonography in the differentiation between benign and malignant myometrial tumors

“…In addition, the use of minimal invasive methods will lead to greater potential satisfaction of the patient and the surgeon. This becomes even more important when a hysterectomy is necessary due to the malignant nature of the mass [ 3 ]. More important, the lack of pretreatment suspicion of malignant lesions such as leiomyosarcoma may expose the affected patients to increase the likelihood of intra-peritoneal dissemination as well as distance metastases and in this regard, the demarcation between conservative treatments and invasive surgery is also difficult [ 4 ].…”